P98. Radiographic sagittal alignment in the asymptomatic elderly: what is normal for age?

Abstract

BACKGROUND CONTEXT Over the past several years, there has been an increasing awareness of the impact of positive sagittal alignment in the overall health related quality of life (HRQOL). However, attempts to restore normal spino-pelvic parameters in the elderly population can introduce challenges with risk factors inherent in this age group, and complications such as proximal junctional failure are high. PURPOSE The purpose of this study was to help define ‘normal for age’ sagittal vertical axis (SVA) in asymptomatic individuals ranging 60 to 80 years in order to facilitate most appropriate care. STUDY DESIGN/SETTING This is a prospective cohort study. PATIENT SAMPLE One hundred and fifty-one volunteers were recruited and divided into age groups of 60, 65, 70, 75 and 80 years with equal numbers of men and women. Exclusion criteria included any history of back pain requiring medical attention within previous year, prior spinal surgery, neuromuscular condition, or compression fracture. OUTCOME MEASURES The primary outcome measure was the SVA and secondary measurements included thoracic kyphosis (T4-T12), total lumbar lordosis (L1-S1), lumbar lordosis (L4-S1), pelvic tilt (PT), pelvic incidence (PI), pelvic incidence lumbar lordosis mismatch (PI-LL), sacral slope (SS), and T1 spino-pelvic inclination (T1SPi) were made using Surgimap software. Oswestry Disability Index (ODI);Veterans Rand 12 (VR-12) HRQOL measures were completed. METHODS After informed consent, subjects completed PROMs and full-standing lateral radiographs were obtained. All statistical analysis was conducted with SAS/STAT version 9.4 (Carey, NC). Normality testing was performed and all radiographic measurements were normally distributed and the ODI and VR12 scores were not normally distributed. Measures of central tendency and variance were calculated. Kruskal Wallis tests were used to determine differences across age groups in the ODI and VR12 scores. An analysis of variance with a least square (LS) means test and a Tukey-Kramer adjustment was used to compare, unadjusted and adjusted by gender, differences in all radiographic measurements across age groups. RESULTS There was no significant (p=.07) difference in the gender adjusted LS mean SVA (mm) across age-groups. For the 60, 65, 70, 75 and 80-year old age groups were (20.2, 19.7, 27.7, 37.3, 37.9), respectively which are were in the normal range of CONCLUSIONS Elderly patients with ASD undergoing corrective surgery are vulnerable to increased complications which can negatively affect HRQL outcomes. Our study showed that asymptomatic elderly individuals maintain a normal sagittal profile with an average SVA FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.